Interfascial intercostal nerves block: alternative to epidural analgesia in open gastrectomy? Report on 4 clinical cases
Keywords:
Gastrectomy, Nerve Block, Analgesia, Epidural, Ultrasonography, Pain
Abstract
The ultrasound-guided intercostal nerves (cutaneous branches) block in the mid-axillary line at the level of the 8th rib (modified BRILMA) is an analgesic technique described back in 2015. Four patients undergoing open gastrectomy (who are not candidates for epidural analgesia) are discussed. The patients underwent the above-mentioned bilateral block, with the administration of 15 mL of levobupivacaine 0.5% into the fascial plane, between the serratus anterior muscle and the external intercostal muscle, with the aim of blocking the intercostal nerves T6 to 11. Postoperative pain control was adequate, with low levels of opioids used. There were no complications associated with the technique.
References
1. Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Sys Rev 2013;CD004088.
2. Fernández Martín MT, López Álvarez S, Mozo Herrera G, et al. Ultrasound-guided cutaneous intercostal branches nerves block: A good analgesic alternative for gallbladder open surgery. Rev Esp Anestesiol Reanim 2015;62:580-584.
3. Austrup ML, Korean G. Analgesic agents for the postoperative period. Opioids Surg Clin North Am 1999;79:253-273.
4. Cook TM, Counsell D, Wildsmith JA. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetist. Br J Anaesth 2009;102:179-190.
5. Niraj G, Kelkar A, Jeyapalan I. Comparison of analgesic efficacy of subcostal Transversus Abdominis Plane Block with epidural analgesia following upper abdominal surgery. Anaesthesia 2011; 66:465-471.
6. Swenson BR, Gottschalk A, Wells LT, et al. Intravenous lidocaine is as effective as epidural bupivacaine in reducing ileus dutation, hospital stay, and pain alter open colon resection: a randomized clinical trial. Reg Anesth Pain Med 2010;35:370-376.
7. Bonnet F, Marret E. influence of anaesthetic and analgesic techniques on outcome after surgery. Br J Anaesth 2005;95:52-58.
8. Rozen WM, Tran TM, Asthon MW, et al. Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin Anat 2008;21:325-339.
9. Hebbard PD, Barrington MJ, Vasey C. Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: description of anatomy and clinical technique. Reg Anesth Pain Med 2010;35:436-441.
10. Wu Y, Liu F, Tang H, et al. The analgesic efficacy of subcostal transversus abdominis plane block compared with thoracic epidural analgesia and intravenous opioid analgesia after radical gastrectomy. Anesth Analg 2013;117:507-513.
11. Niraj G, Kelkar A, Jeyapalan I, et al. Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery. Anaesthesia 2011;66:465-471.
12. Ripollés J, Mezquita SM, Abad A, et al. Analgesic efficacy of the ultrasound-guided blockade of the transversus abdominis plane; a systematic review. Braz J Anesthesiol 2015;65:255-280.
13. Diéguez García P, Fajardo Pérez M, López Álvarez S, et al. Ultrasound-assisted approach to blocking the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery. Rev Esp Anestesiol Reanim 2013;60:365-370.
14. Pérez Herrero MA, López Alvarez S, Fabrique Fuentes A, et al. Quality of postoperative recovery after breast surgery. General anaesthesia combined with paravertebral versus serratus-intercostal block. Rev Esp Anestesiol Reanim 2016;63:564-531.
2. Fernández Martín MT, López Álvarez S, Mozo Herrera G, et al. Ultrasound-guided cutaneous intercostal branches nerves block: A good analgesic alternative for gallbladder open surgery. Rev Esp Anestesiol Reanim 2015;62:580-584.
3. Austrup ML, Korean G. Analgesic agents for the postoperative period. Opioids Surg Clin North Am 1999;79:253-273.
4. Cook TM, Counsell D, Wildsmith JA. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetist. Br J Anaesth 2009;102:179-190.
5. Niraj G, Kelkar A, Jeyapalan I. Comparison of analgesic efficacy of subcostal Transversus Abdominis Plane Block with epidural analgesia following upper abdominal surgery. Anaesthesia 2011; 66:465-471.
6. Swenson BR, Gottschalk A, Wells LT, et al. Intravenous lidocaine is as effective as epidural bupivacaine in reducing ileus dutation, hospital stay, and pain alter open colon resection: a randomized clinical trial. Reg Anesth Pain Med 2010;35:370-376.
7. Bonnet F, Marret E. influence of anaesthetic and analgesic techniques on outcome after surgery. Br J Anaesth 2005;95:52-58.
8. Rozen WM, Tran TM, Asthon MW, et al. Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin Anat 2008;21:325-339.
9. Hebbard PD, Barrington MJ, Vasey C. Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: description of anatomy and clinical technique. Reg Anesth Pain Med 2010;35:436-441.
10. Wu Y, Liu F, Tang H, et al. The analgesic efficacy of subcostal transversus abdominis plane block compared with thoracic epidural analgesia and intravenous opioid analgesia after radical gastrectomy. Anesth Analg 2013;117:507-513.
11. Niraj G, Kelkar A, Jeyapalan I, et al. Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery. Anaesthesia 2011;66:465-471.
12. Ripollés J, Mezquita SM, Abad A, et al. Analgesic efficacy of the ultrasound-guided blockade of the transversus abdominis plane; a systematic review. Braz J Anesthesiol 2015;65:255-280.
13. Diéguez García P, Fajardo Pérez M, López Álvarez S, et al. Ultrasound-assisted approach to blocking the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery. Rev Esp Anestesiol Reanim 2013;60:365-370.
14. Pérez Herrero MA, López Alvarez S, Fabrique Fuentes A, et al. Quality of postoperative recovery after breast surgery. General anaesthesia combined with paravertebral versus serratus-intercostal block. Rev Esp Anestesiol Reanim 2016;63:564-531.
How to Cite
1.
Fernández-Martín MT, López-Álvarez S, Fajardo-López M. Interfascial intercostal nerves block: alternative to epidural analgesia in open gastrectomy? Report on 4 clinical cases. Colomb. J. Anesthesiol. [Internet]. 2018 Jul. 1 [cited 2024 Apr. 26];46(3):259-63. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/547
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Published
2018-07-01
How to Cite
1.
Fernández-Martín MT, López-Álvarez S, Fajardo-López M. Interfascial intercostal nerves block: alternative to epidural analgesia in open gastrectomy? Report on 4 clinical cases. Colomb. J. Anesthesiol. [Internet]. 2018 Jul. 1 [cited 2024 Apr. 26];46(3):259-63. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/547
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Section
Case Report / Case Series
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